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Student Member Online Application

Payment Instructions: Please note that the next screen will continue with payment by credit card via PayPal, keep your credit card ready before proceeding.

Those who are currently enrolled in a marketing related degree at a recognized or internationally equivalent, college/university may qualify to apply to become an IIMP student member:

• Student Member Registration fee for new each member: $45.00 (U.S. Funds).
• Student Member Renewal Fee for each member: $35.00 (U.S. Funds).
• Discounted annual fee for existing members of any recognized marketing
associations: $22.50 (U.S. Funds).


Student Information

Surname:
Given Name:

Middle Name:

Home Phone:

Cell Phone:

Email:

Address:

City:

Postal/Zip Code:

Province/State:

Country:


Please check box, if this is your preferred mailing address.



Education Information

Educational Institution Name:

Program Name:

Program Type:

Program Start Date:

Program Completion Date:

Website:

Registrar's Office Phone:

Address:

City:

Postal/Zip Code:

Province/State:

Country:



Employment Information

Employer Name:

Your Job Title:

Website:

Work Phone:

Address:

City:

Postal/Zip Code:

Province/State:

Country:


Please check box, if this is your preferred mailing address.



Online Login Information

Login Name: 5-12 letters/numbers

Password: 5-12 letters/numbers




Payment Information

Membership Fee: (U.S. Funds)

Please note: the next screen will continue with credit card payment by PayPal.



Membership Information with other Marketing Association
(Complete this section, if applying for special discount)

Association Name:

Your Membership No:

Website:

Contact Name:

Phone:

Address:

City:

Postal/Zip Code:

Province/State:

Country:


Check box, in order to authorize us to verfiy your memberhsip information


Authorizations

Include your information in IIMP™’s online membership directory.
Email you information about IIMP™’s upcoming event and activities.
Permit third parties to contact you about promotional information.
Accept IIMP™'s Membership Agreement.


Comments/Questions (optional):



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